Thesis advisor: June Horowitz / Pain in extremely low gestational age (ELGA) infants remains under-assessed and poorly managed despite the fact that pain may have profound consequences with regard to infants' neuro-development (Als, 1982). Pain prevention is a critical goal of pain assessment, yet barriers exist. Most critical is the lack of valid, reliable, and clinically useful pain tools. This observational descriptive study focused on the development of a gestational age appropriate instrument for 24-29 6/7 week infants and evaluation of the new instrument, Pain Assessment and Care for the Extremely Low Gestational Age Infant Focused Instrument (PACEFI). Additionally, differences in behavioral cues and physiologic indicators were evaluated for ELGA infants and very low gestational age (VLGA) infants for non-invasive and invasive procedures. Nurse raters used the PACEFI to rate these infants during both procedures at baseline, during, and recovery to assess variation in expected pain. The PACEFI demonstrated a high internal consistency (.879) and appeared to be contributing to the measurement of pain. A RANOVA found a significant difference in rating scores ( p < .001) for both procedures. Baseline and recovery scores were lower than during scores. ELGA infants demonstrated a dampened response (p < .023) as compared to the VLGA infants during the invasive procedure. Alternatively, ELGA infants demonstrated a more vigorous response for non-invasive procedure and dropped below baseline scores at recovery. The whole care experience during the non-invasive procedure may have led to sensitization for the VLGA infant and overwhelming energy expenditure for the ELGA infant. Furthermore, physiologic indicators and behavioral cues were inconsistent arguing for independent assessment of these parameters. Knowledge gained from this study: 1) provides information regarding gestational age differences in pain behaviors; and (2) clarifies if the measurement of these behaviors addresses the immediate need for pain assessment for this vulnerable population. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

<p><strong>Bakgrund: </strong>Den vanligaste faktorn till att människor söker vård idag är på grund av smärta. Sjuksköterskan har en viktig roll genom att kunna tillämpa de omvårdnadsåtgärder som krävs vid ett smärttillstånd på ett korrekt sätt. <strong>Syfte: </strong>Litteraturstudiens syfte var att beskriva sjuksköterskans tillämpning av omvårdnadsåtgärder vid smärta hos vuxna individer. <strong>Metod: </strong>En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Analys gjordes av sjutton artiklar. <strong>Resultat:</strong> Analysen resulterade i tre teman, <em>Att smärtbedöma, Att smärtskatta och Att smärtlindra, </em>vilket innefattar faktorer som påverkar hur sjuksköterskan tillämpar omvårdnadsåtgärder vid smärta. <strong>Slutsats: </strong>Sjuksköterskors attityder och bristande kunskaper inom området leder till oförmågan att tillämpa åtgärder i sin helhet. Utbildning och fasta rutiner har visat sig ha en positiv inverkan på sjuksköterskors attityder och användandet av bedömningsinstrument.</p>

Bakgrund: Den vanligaste faktorn till att människor söker vård idag är på grund av smärta. Sjuksköterskan har en viktig roll genom att kunna tillämpa de omvårdnadsåtgärder som krävs vid ett smärttillstånd på ett korrekt sätt. Syfte: Litteraturstudiens syfte var att beskriva sjuksköterskans tillämpning av omvårdnadsåtgärder vid smärta hos vuxna individer. Metod: En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Analys gjordes av sjutton artiklar. Resultat: Analysen resulterade i tre teman, Att smärtbedöma, Att smärtskatta och Att smärtlindra, vilket innefattar faktorer som påverkar hur sjuksköterskan tillämpar omvårdnadsåtgärder vid smärta. Slutsats: Sjuksköterskors attityder och bristande kunskaper inom området leder till oförmågan att tillämpa åtgärder i sin helhet. Utbildning och fasta rutiner har visat sig ha en positiv inverkan på sjuksköterskors attityder och användandet av bedömningsinstrument.

Pain is experienced in 30-50% of cancer patients during active antineoplastic therapy and in 60-90% of patients with advanced cancer. One of the root causes for inadequate medication is inadequate pain assessment. Therefore, a hospital-based quasi-experimental study was implemented to evaluate the effect of a continuing education and institutionalization program¡]CEI¡^on nurses¡¦ cancer pain assessment. There were 57 frequency-matched patient-nurse dyads were interviewed by the structured questionnaire at three different stages (pre-test, post-continuing education and post- institutionalization ). After these 171 patients were discharged, their charts were reviewed and abstracted. Chi-square test and ANOVA were used in the statistical analysis. The results showed that CE only made statistically significant improvement on patients¡¦ pain impact of relationship, pain impact of sleep, satisfaction, and hesitancy to report pain. Additionally, institutionalization made significant improvement on patient¡¦s now pain and average pain severity, nurses¡¦ accurate assessment of patient¡¦s pain ratings of mild pain and expected pain, and documentation of pain assessment. In conclusion, CE and institutionalization of cancer pain assessment were effective in cancer pain management in two different fields, one was the improvement of patient¡¦ pain severity and satisfaction and the other was the improvement of nurse¡¦s practices of cancer pain assessment. Quality comes from improving the process , not evaluating the output after fact. The suggestion was that the head nurse of the ward audited actively on unit and rewards for chart documentation. The management of good quality required the good administrator. To whom persisted endless of quality improvement , they can study the further analysis and comparison within five years after institutionalization.

MSc Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Critically ill patients are particularly vulnerable to pain as a result of the severity of their disease conditions, diagnostic and treatment interventions but pain management is not considered a priority in the Intensive Care Unit (ICU) team (Holden, 1991: Walsh & Ford, 1992). Pain causes complications in the ICU patient, which increases their ICU stay and cost of ICU treatment (Pooler-Lunse & Price, 1992). The purpose of this study was to describe the parameters identified by ICU nurses that can be used to assess pain in the critically ill unconscious patient in the adult Intensive Care Units and whether these parameters are considered by the ICU nurses when managing the unconscious patients’ pain. The objectives of the study were to describe the parameters identified by ICU nurses that can be used for assessing pain in unconscious patients and to determine whether these parameters were considered by ICU nurses when managing the unconscious patient’s pain. A non-experimental, descriptive, prospective, comparative, two part design was used for the study. The sample comprised of ICU nurses (n = 40) in four adult ICU’s and the unconscious patients (n = 40) they nursed. Part one involved the nurses’ responses to a self administered Likert-type questionnaire about parameters that could be indicative of pain in the unconscious patient and part two involved a prospective record review of the unconscious patients ICU charts. A comparison was then done between these two parts to determine if the parameters identified by ICU nurses that could be indicative of pain in the unconscious patient, were considered in their management of the unconscious patients pain. Descriptive statistics were used to analyse data. Of the responses elicited from the questionnaire, ICU nurses agreed that raised blood pressure, pyrexia, increased respiratory rate, dilated pupils and increased heart rate could all be indicative of pain in the unconscious patient but these did not influence their management of the unconscious patient’s pain.

No description available.

Bakgrund Antalet äldre ökar alltmer i världen och därmed även personer med demens. Det uppskattas att hälften av alla personer med demens lever med en smärta. Demenssjukdom medför svårigheter att kommunicera och förmedla smärta. Sjuksköterskorna får hitta andra sätt att bedöma smärta hos personer med demens vilket ofta innebär observationerav icke-verbala tecken på smärta. Syfte Syftet var att studera sjuksköterskors erfarenheter av att bedöma smärta hos personer med demens. Metod Studien var en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter. Resultat Resultatet innehöll huvudkategorin; sjuksköterskors erfarenheter av vad som underlättar respektive försvårar bedömning av smärta och underkategorierna; organisation, kommunikation, samverkan samt kunskap och erfarenhet. Sjuksköterskornas erfarenheter var att kommunikationssvårigheter, personalbrist, tidsbrist, kunskapsbrist, försvårar bedömningen av smärta hos patientgruppen. Kunskap, erfarenhet, fungerande kommunikation med andra professioner i vårdteamet och anhöriga underlättar bedömning av smärta för sjuksköterskor. Slutsats Sjuksköterskorna beskrev många hinder som försvårade bedömningen av smärta hos personer med demens och fann egna strategier som underlättade bedömningen. Sjuksköterskor använder sällan bedömningsinstrument och baserar bedömning av smärta på sin intuition. / Background The number of elderly is steadily increasing in the world and with that follows a great number of persons with dementia. It is estimated that around 50% of all persons with dementia suffers from pain. Dementia causes a cognitive impairment that leads to difficulties in communicating and conveying pain. The nurses have to find other ways to assess pain in persons with dementia which often involves observations of non-verbal signs of pain. Aim The Aim was to explore nurses experience of assessing pain in persons with dementia. Method The study was a structured literature review with elements of the methodology used in systematic reviews. Results The result included the main category; nurses' experiences of what facilitates and hinders the assessment of pain and the subcategories; organization, communication, collaboration, knowledge and professional experience. The nurses' experiences were that communication difficulties, lack of staff, time and knowledge make it difficult to assess pain. Knowledge,experience, effective communication with colleagues and relatives facilitates the assessment of pain for nurses. Conclusions The nurses described many obstacles that made it difficult to assess pain in people with dementia, they found their own strategies that facilitated the assessment of pain. Nurses rarely use pain scales, they use their intuition to assess pain.

Smärta är den vanligaste sökorsaken för patienter på akutmottagningar, trots detta visar forskning att underbehandling av akut smärta förekommer över hela världen På grund av att smärta är subjektiv kan det vara mycket svårt att mäta patienternas smärta. Bedömningen av smärta bygger på patienternas självskattning. Adekvat bedömning av smärta är avgörande för att effektiv smärtlindring ska kunna ges. Syftet med kvalitetförbättringsstudien var att införa ett nytt smärtskattningsverktyg samt att utvärdera om en utbildningsintervention i form av korta utbildningstillfällen kan öka antalet smärtskattningar på en akutmottagning. Studien hade en kvasi-experimentell design. Avbruten tidsserie användes för utfallsmätning före och efter utbildningsinterventionen. Utbildningsinterventionen bestod av korta utbildningstillfällen under en veckas tid där information gavs om smärtskattning med hjälp av smärtskattningsskalan Verbal Rating Scale och hur smärtskattningen skulle dokumenteras. Studien utfördes simultant på två akutmottagningar i södra Sverige under en period av totalt 13 veckor under våren 2022. Resultatet av studien visar att före interventionen genomfördes i medel 5,6% smärtskattningar och efter interventionen ökade antalet smärtskattningar per vecka i till 9,3%. Kvalitetsförbättringsstudien har varit till fördel på respektive akutmottagning då dokumentation av smärtskattning har ökat. För att bibehålla och vidareutveckla denna kunskap krävs det fortlöpande utbildningstillfällen och påminnelser kring smärtskattning samt regelbunden utvärdering av mängden dokumenterad smärtskattning. / Pain is the most presenting complaint to emergency departments. Despite this, research shows that undertreatment of acute pain occurs worldwide Because pain is subjective, it can be very difficult to measure patients pain. The valuation of pain is based on patients self-assessment. Adequate assessment of pain is crucial for effective pain relief to be provided. The purpose of this study was to introduce a new pain assessment tool and to evaluate whether an educational intervention in the form of short training sessions can increase the number of pain estimates in an emergency department. The study had a quasi-experimental design. Interrupted timeseries was used for outcome measurement before and after the training intervention. The training intervention consisted of short micro sessions over a period of one week where information was given about pain assessment using the Verbal Rating Scale and how the pain assessment was to be documented. The study was performed simultaneously in two emergency departments in southern Sweden for a period of a total of 13 weeks in the spring of 2022. The results of the study show that before the intervention, 5.6% pain estimates were performed and after the intervention the number of pain estimates per week increased to 9.3%. The quality improvement study has been to the advantage of the respective emergency department as documentation of pain assessment has increased. In order to maintain and further develop this knowledge, continuous training opportunities and reminders about pain assessment are required, as well as regular evaluation of the amount of documented pain assessment.

Smärta är idag ett omfattande hälsoproblem. Idag finns det mycket kunskap omsmärta, effektiva smärtstillande läkemedel och metoder för smärtlindring inom hälsoochsjukvården. Trots detta får många patienter inte tillräcklig smärtbehandling. Föratt uppnå en optimal smärtbehandling är det viktig att sjuksköterskor genomför enadekvat smärtbedömning och har kunskap om de faktorer som påverkarsmärtbedömningen. I litteraturstudien granskades och analyserades totalt 10 artiklar,åtta kvantitativa, en kvalitativ och en med mixad metod. Resultatet visar att det finnsolika faktorer som påverkar smärtbedömningen. De faktorerna är: bedömning avsmärtintensitet, kunskap om riktlinjer, kunskapsnivå och erfarenhet, sociala faktoreroch dokumentation. Erfarna sjuksköterskor har högre tilltro till sina egna objektivabedömningar än till patienters subjektiva smärt-upplevelse vilket leder tillunderskattning av patientens smärta. Tillämpning av kliniska riktlinjer leder till attsjuksköterskor genomför en adekvat smärtbedömning. Patientens smärta kan påverkasnegativt av partners empati och socialt hot. Försening och otillräcklig dokumentationav smärtbedömning påverkar smärtlindringen vilket leder till onödig smärta ochlidande hos patienten. Brist i konsekvent användning av smärtskattningsskalor, ingaobserverade ändringar i de vitala parametrarna kopplade till smärta, tidsbrist ärytterligare faktorer som påverkar smärtbedömningen negativt. Framtida forskningbehövs för att identifiera faktorer som påverkar smärtbedömningen så attkompetensen hos hälso- och sjukvårdspersonalen ökar. / Pain is today an extensive health problem. A lot of knowledge exists today aboutpain, effective pain reducing medicines and methods to provide pain easement withinthe health and medical care. Despite those facts a lot of patients do not receiveadequate pain treatment. To achieve an optimal pain treatment is it important thatnurses performs an adequate pain assessment and has knowledge about the factorsthat influence the pain assessment. The study is a literature review that is based on tenarticles whereof eight are quantitative, one qualitative and one with mixed methods,those articles where studied and analyzed. The result shows that different factors thatinfluences the pain assessment exists. Those factors are: assessment of pain intensity,knowledge about guidelines, competence level and experience, social factors anddocumentation. Experienced nurses have higher belief on their own objectiveassessments than to the patient’s subjective pain experience, this leads to anunderestimation of the pain experienced by the patient. Application of clinicalguidelines leads to that nurse performs an adequate pain assessment. The patient’spain can be negatively impacted of their relatives’ empathy and by a social threat.Late or insufficient pain assessment documentation impacts the pain relief whichleads to unnecessary pain and suffering for the patients. Lack of a consequent use ofpain rating scales, no observed changes in the vital parameters related to pain and lackof time are additional factors that influences the pain assessment negative. Futureresearch is needed to identify factors that influence the pain assessment.

Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.